Q: What is the most major adverse effect of SSRI? A: Sexual dysfunction

Q: Which mood drug class can give you nausea, dizziness, and headache after you stop using it for 1-3 days? A: SSRI — this is called SSRI Discontinuation Syndrome

Q: What mood drug has significantly less side effects than the main mood drugs, but does lower seizure threshold and does not cause sedation, cardiovascular effects, anticholinergic effects, “switching” to mania/hypomania, or sexual dysfunction? A: Bupropion

Q: What are the side effects of bupropion? A: Remember, bupropion has very little side effects, but it does lower seizure threshold (dose related), decreases appetite, and cause agitation.

Q: What mood drug has significantly less side effects than the main mood drugs, but does NOT lower seizure threshold, but DOES cause sedation? A: Mirtazapine

Q: How long do you have to wait between taking MAOI and SSRI/SNRI/TCA/Bupropion? A: 14 days

Q: How long after taking fluoxetine can you take a MAOI? A: 5 weeks

Q: What is the mechanism of action for TCAs? A: inhibit reuptake of 5-HT and NE (like SNRI) at presynaptic neuron.

Q: What TCA do you use to treat Obsessive Compulsive Disorder? A: Clomipramine (“clone my pralines”)

Q: What TCA do you use to treat Panic Disorder? A: Imipramine (“I’m a’panicking”)

Q: What are the five common TCA’s covered in lecture? A: Clomipramine, Amitriptyline, Nortriptyline, Desipramine, Imipramine (“TCA CANDI”)

Q: Desipramine is the active metabolite of what, and therefore has less sedation/anticholinergic/hypotension side effects? A: Imipramine (“Imi becomes Desi”)

Q: Nortriptyline is the active metabolite of what, and therefore has less sedation/anticholinergic/hypotension side effects? A: Amitriptyline (“Ami becomes Nora”)

Q: Most antidepressants can cause suicidal behavior in kids. What are the only two antidepressants that are approved in children? A: Fluoxetine and Escitalopram

BIPOLAR DRUGS

Q: What three classes of drugs do you use to treat bipolar disorder? A: Mood stabilizers (i.e. lithium, valproic acid, carbamazepine, lamotragine, other antiepileptic drugs), Antidepressants, and Antipsychotics.

Q: What drugs do you use to treat the depression part of bipolar disorder? A: Antidepressants

Q: What drugs do you use to treat the mania part of bipolar disorder (for both acute and prophylaxis/maintenance)? A: Mood stabilizers and Antipsychotic drugs

Q: What drugs do you use to maintain or prevent (prophylaxis) bipolar disorder episodes? A: Mood stabilizers (including Lamotragine)

Q: What antidepressant drug has less risk of antidepressant-induced mania/hypomania and therefore is better for bipolar disorder? A: Bupropion

Q: What are the adverse effects of lithium? A: GI irritation, tremor, metallic taste, COGNITIVE DULLING. When used long term, like for maintenance, can also cause weight gain, acne, polydipsia/polyuria/nephrogenic diabetes insipidus, hypothyroidism.

Q: What two special adverse effect does Carbamazepine cause? A: Steven Johnson Syndrome (“Steve likes carbs and lambs” — carbamazepine and lamotragine both can cause SJS). Also can cause agranulocytosis, so need to monitor WBC.

Q: What’s unique about the metabolism of Carbamazepine? A: It induces its own metabolism (within 4-8 weeks) because it induces CYP450 but also gets metabolized by CYP450. So you have to constantly monitor and adjust its level. Because it induces CYP450, it also reduces the levels of oral contraceptives.

Q: Why do you ask a bipolar patient if they are taking oral contraceptives? A: Because carbamazepine induces CYP450, which metabolizes oral contraceptives. Prescribe something else if they are taking oral contraceptives.

Q: What’s the MOA of Carbamazepine? A: increase the inactivation of Na channels (“salt granules, fennel, and lambs flying through a maze of pine trees” — Phenytoin, Carbamazepine, and Lamotrigine all work by inactivating Na channels)

Q: What are the major adverse effects of lamotrigine? A: SJS (Steven Johnson syndrome) and TEN (toxic epidermal necrolysis)

ANXIETY DRUGS

Q: What classes of drugs can you use to treat Anxiety? A: Antidepressants, Benzodiazepines (if rapid effect needed, like in panic attacks), and two others (buspirone and clonidine)

Q: How long does it take benzodiazepines to work? A: 30 minutes to an hour (vs. antidepressants, which take 3-4 weeks). Therefore it is used in panic attacks that occur all of a sudden.

Q: What neurotransmitter is implicated in anxiety? A: Too little GABA

Q: This isn’t on the test, but what is the generic name for Xanax? A: Alprazolam (a benzodiazepine)

Q: What are the adverse effects of benzodiazepines? A: Sedation, DEPENDENCE (so it can be abused), Withdrawal syndrome, Potentiation of alcohol (because binds to same chloride channel as benzodiazepine).

Q: What can you use to treat OCD? A: Clomipramine, and the SSRIs (flu flu ser par cit escit)

Q: What are the high potency benzodiazepines that can be used to treat anxiety and panic? A: Alprazolam and Clonazepam.

Q: Why is alcohol a depressant? A: Because like benzodiazepines and barbiturates and GABA, it binds to the chloride channel and hyperpolarizes the neuron (remember Physio I?)

Q: What can you use to treat alcohol withdrawal? A: Benzodiazepine, because it binds to same chloride channel as alcohol.

Q: What is the most important adverse effect of benzodiazepine? A: Sedation (like TCAs, therefore used in hypnotics), Dependence, Withdrawal (anxiety, myoclonic jerks, seizures)

Q: Why do you have to be careful when giving benzodiazepines and digoxin together? A: because benzodiazepines increase the half life of digoxin

Q: What drug is a benzodiazepine antagonist? A: Flumazenil — reverses the action of benzodiazepines at the benzodiazepine receptor only (not EtOH or barbiturate receptors). Used in reversing benzodiazepine sedation or overdose.

Q: What are the adverse effects of ACHEI?
A: diarrhea, weight loss (vs. Memantine, which gives you constipation and dizziness)

Q: MOA for memantine?
A: It is an NMDA antagonist, and therefore decreases Glutamate signal. In Alzheimer’s disease, too much excitation from glutamate causes neurotoxicity, damaging neurons in the brain, which worsens Alzheimers. Memantine is used for severe Alzheimers.

Q: Can you cure Alzheimers with these drugs? What do these drugs really do for Alzheimer patients?
A: No. You can only raise the cognitive performance of patients initially above the baseline. But then after 6 months, it starts declining. Basically with AChEI drugs, you just delay the decline in cognitive performance in the beginning. Once Alzheimers is severe in the patient, then use Memantine.

PARKINSON DRUGS

Q: What kind of drugs can you use to treat Parkinson’s Disease? A: The inherent problem in Parkinson Disease is the lack of Dopamine. Therefore, you use Dopaminergic drugs, or Anticholinergic drugs. Remember in the Nigro-Striatal-Nigral Feedback loop, ACh stimulates GABA release, which inhibits DA. Therefore if you decrease ACh, you decrease GABA, and increase DA. Also remember that the point is to get DA and ACh levels balanced. So you can do this either by increasing DA or decreasing ACh, and therefore you can use either dopaminergic or anticholinergic drugs.

Q: What drug is best as a “rescue treatment” during the “off” period of Parkinson Disease?
A: Apomorphine

Q: What COMT inhibitors can you use to treat Parkinson?
A: Entacapone (used as adjunct), Tolcapone (gives you hepatotoxicity)

Q: What MAO-B inhibitors can you use?
A: Selegiline (used as adjunct), Rasagiline (gives you hepatotoxicity)

Q: What are the adverse effects of Trihexyphenidyl and Benztropine?
A: Sedation, Confusion

HUNTINGTON DRUGS

Q: What three drug classes can you use to treat Huntingtons?
A: Since the problem is in too much DA due to loss of GABA, you can treat Huntington Disease with D2 antagonists, Monoamine Depleters. You can also treat with cholinergic drugs. The point is to get DA and ACh levels balanced. So this would mean either decreasing DA or increase ACh.

Q: How does disulfiram work to treat alcohol abuse? A: It blocks Aldehyde Dehydrogenase, making you accumulate a lot of aldehyde if you drink alcohol. This makes you feel ill and makes you not want to drink alcohol ever again.

Q: What symptoms do you see in opiate overdose?
A: You depress sympathetic nerves too much — pinpoint pupils, coma, respiratory depression

Q: What symptoms do you see in opiate withdrawal?
A: increased sympathetic — pupil dilation, restlessness

Q: What drug is used to treat heroin withdrawal because it is similar to heroin but has a much longer half life?
A: Methodone. KNOW THIS!!!

Q: What drugs are used to treat opioid toxicity because they are opioid antagonists?
A: Naloxone and Naltrexone

Q: What drug is used to treat both opioid toxicity and alcohol abuse?
A: Naltrexone

Q: What is the maintenance drug for opioid-dependent patients because of its long half-life?
A: Buprenorphine

Q: What is significant about glycolate? A: it causes the metabolic acidosis in ethylene glycol intoxication

Q: What is significant about oxalate? A: it crystallizes in the kidneys, causing the renal damage seen in ethylene glycol intoxication

Q: How do you treat the metabolic acidosis found in methanol and ethylene glycol? A: treat wit sodium bicarbonate

Q: How do you treat methanol and ethylene glycol overdose? A: You give the patient EtOH. The EtOH competes with the methanol and ethylene glycol in binding alcohol dehydrogenase, preventing the methanol and ethylene glycol from getting metabolized into the harmful products.

Q: How do you increase the elimination of methanol and ethylene glycol during overdose? A: Give patient folic acid or hemodialysis if its really bad.

SCHIZOPHRENIA DRUGS (ANTIPSYCHOTIC DRUGS)

Q: What is the key to treating Schizophrenia?
A: antagonizing D2, and if you’re really good, antagonizing D2 and 5HT-2

Q: Why D2 and 5HT2?
A: Because D2 works in the brain and 5HT-2 is responsible for increasing CNS and cardiovascular stimulation.

Q: In what four pathways do you find D2 receptors?
A: 1. Mesolimbic pathway — a decrease in D2 causes antipsychotic effects. This is what we target in Schizophrenia. 2. Mesocortical pathway — a decrease in D2 causes antipsychotic effects. This is what we target in Schizophrenia. 3. Nigrostriatal pathway — a decrease in D2 causes parkinsonism or Extrapyramidal Symptoms (EPS).
4. Tuberoinfundibular pathway — a decrease in D2 causes increase in prolactin.

Q: What is the difference between the positive and negative symptoms of schizophrenia? A: positive: delusions, hallucinations negative: apathy, anhedonia, flat affect

Q: Which generation antipsychotic drugs treats both positive and negative symptoms? A: second generation. first generation only treats positive symptoms of schizophrenia.

Q: Which first generation antipsychotic drug is the most potent, and only adverse effect is EPS?
A:Haloperidol (which is a butyrophenone)

Q: What are the major side effect of conventional (first-generation) antipsychotics? A: Extrapyramidal symptoms (EPS), Neuroleptic Malignant Syndrome. Not as much in second generation.

Q: What is it called when a patient on antipsychotics suddenly have muscle rigidity, autonomic instability, elevated CPK, and changing levels of consciousnes? A: Neuroleptic Malignant Syndrome. It is an emergency and can lead to death.

Q: Why do antipsychotics also often cause orthostatic hypotension and sedation? A: Because they also block H1, M1, and A1 — Multiple Receptor Effects.

Q: What drug do you use if you use too much phenylephrine? A: Thymoxamine, Dapiprazole – Alpha-1 antagonists – reverses pupil dilation from phenylephrine, a glaucoma drug.

Q: What is the best class of drugs for glaucoma? A: Carbonic Anhydrase Inhibitors – Acetazolamide, Methazolamide, Dichlorphenamide, Dorzalamide, Brinzolamide. They all have zol or zal except dichlorphenamide.

Q: Which local anaesthesia gives you methemoglobin as an adverse effect? A: Prilocaine.

Q: Local anaesthetics are metabolized by what? A: Ester are metabolized by plasma cholinesterase.Amides are metabolized by CYP450.

Q: All local anaesthetics are vasodilators except…? A: Cocaine – vasoconstrictor. Because most are vasodilators, the duration of action is short, so you co-give it with a constrictor, like epinephrine.

Q: What drug do you use to treat Schizoaffective disorder? A: Paliperidone – the active metabolite of Risperidone, a second generation schizophrenia drug.